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1.
Chest ; 2020 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-32224074

RESUMEN

BACKGROUND: Since the outbreak of coronavirus disease 2019 (COVID-19) in China in December 2019, considerable attention has been focused on its elucidation. However, it is also important for clinicians and epidemiologists to differentiate COVID-19 from other respiratory infectious diseases such as influenza viruses. RESEARCH QUESTION: The aim of this study was to explore the different clinical presentations between COVID-19 and influenza A (H1N1) pneumonia in patients with ARDS. STUDY DESIGN AND METHODS: This analysis was a retrospective case-control study. Two independent cohorts of patients with ARDS infected with either COVID-19 (n = 73) or H1N1 (n = 75) were compared. Their clinical manifestations, imaging characteristics, treatments, and prognosis were analyzed and compared. RESULTS: The median age of patients with COVID-19 was higher than that of patients with H1N1, and there was a higher proportion of male subjects among the H1N1 cohort (P < .05). Patients with COVID-19 exhibited higher proportions of nonproductive coughs, fatigue, and GI symptoms than those of patients with H1N1 (P < .05). Patients with H1N1 had higher Sequential Organ Failure Assessment (SOFA) scores than patients with COVID-19 (P < .05). The Pao2/Fio2 of 198.5 mm Hg in the COVID-19 cohort was significantly higher than the Pao2/Fio2 of 107.0 mm Hg in the H1N1 cohort (P < .001). Ground-glass opacities was more common in patients with COVID-19 than in patients with H1N1 (P < .001). There was a greater variety of antiviral therapies administered to COVID-19 patients than to H1N1 patients. The in-hospital mortality of patients with COVID-19 was 28.8%, whereas that of patients with H1N1 was 34.7% (P = .483). SOFA score-adjusted mortality of H1N1 patients was significantly higher than that of COVID-19 patients, with a rate ratio of 2.009 (95% CI, 1.563-2.583; P < .001). INTERPRETATION: There were many differences in clinical presentations between patients with ARDS infected with either COVID-19 or H1N1. Compared with H1N1 patients, patients with COVID-19-induced ARDS had lower severity of illness scores at presentation and lower SOFA score-adjusted mortality.

2.
Eur Respir J ; 55(5)2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32269088

RESUMEN

The aim of this study was to identify factors associated with the death of patients with COVID-19 pneumonia caused by the novel coronavirus SARS-CoV-2.All clinical and laboratory parameters were collected prospectively from a cohort of patients with COVID-19 pneumonia who were hospitalised to Wuhan Pulmonary Hospital (Wuhan City, Hubei Province, China) between 25 December 2019 and 7 February 2020. Univariate and multivariate logistic regression was performed to investigate the relationship between each variable and the risk of death of COVID-19 pneumonia patients.In total, 179 patients with COVID-19 pneumonia (97 male and 82 female) were included in the present prospective study, of whom 21 died. Univariate and multivariate logistic regression analysis revealed that age ≥65 years (OR 3.765, 95% CI 1.146‒17.394; p=0.023), pre-existing concurrent cardiovascular or cerebrovascular diseases (OR 2.464, 95% CI 0.755‒8.044; p=0.007), CD3+CD8+ T-cells ≤75 cells·µL-1 (OR 3.982, 95% CI 1.132‒14.006; p<0.001) and cardiac troponin I ≥0.05 ng·mL-1 (OR 4.077, 95% CI 1.166‒14.253; p<0.001) were associated with an increase in risk of mortality from COVID-19 pneumonia. In a sex-, age- and comorbid illness-matched case-control study, CD3+CD8+ T-cells ≤75 cells·µL-1 and cardiac troponin I ≥0.05 ng·mL-1 remained as predictors for high mortality from COVID-19 pneumonia.We identified four risk factors: age ≥65 years, pre-existing concurrent cardiovascular or cerebrovascular diseases, CD3+CD8+ T-cells ≤75 cells·µL-1 and cardiac troponin I ≥0.05 ng·mL-1 The latter two factors, especially, were predictors for mortality of COVID-19 pneumonia patients.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Coronavirus , Neumonía Viral/mortalidad , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Linfocitos T CD8-positivos , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Trastornos Cerebrovasculares/epidemiología , China , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Estudios Prospectivos , Troponina I/sangre
3.
Psychother Psychosom ; 89(1): 38-47, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31846980

RESUMEN

BACKGROUND: Not all adults with chronic insomnia respond to the recommended therapeutic options of cognitive behavioral therapy and approved hypnotic drugs. Transcranial alternating current stimulation (tACS) may offer a novel potential treatment modality for insomnia. OBJECTIVES: This study aimed to examine the efficacy and safety of tACS for treating adult patients with chronic insomnia. METHODS: Sixty-two participants with chronic primary insomnia received 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas in the laboratory on weekdays for 4 consecutive weeks, followed by a 4-week follow-up period. The primary outcome was response rate measured by the Pittsburgh Sleep Quality Index (PSQI) at week 8. Secondary outcomes were remission rate, insomnia severity, sleep onset latency (SOL), total sleep time (TST), sleep efficiency, sleep quality, daily disturbances, and adverse events at the end of the 4-week intervention and at the 4-week follow-up. RESULTS: Of 62 randomized patients, 60 completed the trial. During the 4-week intervention, 1 subject per group withdrew due to loss of interest and time restriction, respectively. Based on PSQI, at 4-week follow-up, the active group had a higher response rate compared to the sham group (53.4% [16/30] vs. 16.7% [5/30], p = 0.009), but remission rates were not different between groups. At the end of the 4-week intervention, the active group had higher response and remission rates than the sham group (p < 0.001 and p = 0.026, respectively). During the trial, compared with the sham group, the active group showed a statistically significant decrease in PSQI total score, a shortened SOL, an increased TST, improved sleep efficiency, and improved sleep quality (p < 0.05 or p < 0.001). Post hoc analysis revealed that, in comparison with the sham group, the active group had improved symptoms, except for daily disturbances, at the end of the 4-week intervention, and significant improvements in all symptoms at the 4-week follow-up. No adverse events or serious adverse responses occurred during the study. CONCLUSION: The findings show that the tACS applied in the present study has potential as an effective and safe intervention for chronic insomnia within 8 weeks.

4.
BMJ Open ; 9(11): e026860, 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31699712

RESUMEN

OBJECTIVES: The objective of this study was to evaluate the association of genetically determined leptin with lipids. DESIGN: We conducted a Mendelian randomisation study to assess a potential causal relationship between serum leptin and lipid levels. We also evaluated whether alcohol drinking modified the associations of genetically determined leptin with blood lipids. SETTING AND PARTICIPANTS: 3860 participants of the Framingham Heart Study third generation cohort. RESULTS: Both genetic risk scores (GRSs), the GRS generated using leptin loci independent of body mass index (BMI) and GRS generated using leptin loci dependent of BMI, were positively associated with log-transformed leptin (log-leptin). The BMI-independent leptin GRS was associated with log-transformed triglycerides (log-TG, ß=-0.66, p=0.01), but not low-density lipoprotein cholesterol (LDL-C, p=0.99), high-density lipoprotein cholesterol (HDL-C, p=0.44) or total cholesterol (TC, p=0.49). Instrumental variable estimation showed that per unit increase in genetically determined log-leptin was associated with 0.55 (95% CI: 0.05 to 1.00) units decrease in log-TG. Besides significant association with log-TG (ß=-0.59, p=0.009), the BMI-dependent GRS was nominally associated with HDL-C (ß=-10.67, p=0.09) and TC (ß=-28.05, p=0.08). When stratified by drinking status, the BMI-dependent GRS was associated with reduced levels of LDL-C (p=0.03), log-TG (p=0.004) and TC (p=0.003) among non-current drinkers only. Significant interactions between the BMI-dependent GRS and alcohol drinking were identified for LDL-C (p=0.03), log-TG (p=0.03) and TC (p=0.02). CONCLUSION: These findings together indicated that genetically determined leptin was negatively associated with lipid levels and the association may be modified by alcohol consumption.

5.
J Neurochem ; 2019 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-31705656

RESUMEN

Sevoflurane is one of the most widely used anesthetics with recent concerns rising about its pediatric application. The synaptic toxicity and mechanisms underlying its long-term cognition impairment remain unclear. In this study, we investigated the expression and roles of homeodomain interacting protein kinase 2 (HIPK2), a stress activating kinase involved in neuronal survival and synaptic plasticity, and its downstream c-Jun N-terminal kinase (JNK)/c-Jun signaling in the long-term toxicity of neonatal Sevoflurane exposure. Our data showed that neonatal Sevoflurane exposure results in impairment of memory, enhancement of anxiety, less number of excitatory synapses and lower levels of synaptic proteins in the hippocampus of adult rats without significant changes of hippocampal neuron numbers. Up-regulation of HIPK2 and JNK/c-Jun was observed in hippocampal granular neurons shortly after Sevoflurane exposure and persisted to adult. 5-((6-Oxo-5-(6-(piperazin-1-yl)pyridin-3-yl)-1,6-dihydropyridin-3-yl)methylene)thiazolidine-2,4-dione trifluoroacetate, antagonist of HIPK2, could significantly rescue the cognition impairment, decrease in long-term potentiation, reduction in spine density and activation of JNK/c-Jun induced by Sevoflurane. JNK antagonist SP600125 partially restored synapse development and cognitive function without affecting the expression of HIPK2. These data, in together, revealed a novel role of HIPK2-JNK/c-Jun signaling in the long-term synaptic toxicity and cognition impairment of neonatal Sevoflurane exposure, indicating HIPK2-JNK/c-Jun cascade as a potential target for reducing the synaptic toxicity of Sevoflurane.

6.
Tob Induc Dis ; 17: 73, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31768165

RESUMEN

INTRODUCTION: Healthcare information systems (HIS) are used to aid healthcare providers delivering brief smoking cessation interventions. However, evidence regarding the effectiveness of intervention models in developing countries remains limited. A smoking cessation intervention model based on a decision support tool embedded in HIS (an 'e-information model', including Ask, Advise, Assess, Inform, Refer and Print components) was applied in a large urban general hospital in Beijing, China. The current study was a preliminary evaluation of the implementation and effectiveness of this model. METHODS: We conducted a retrospective investigation in the outpatient department of the hospital in the period June-July 2017. Using a paper questionnaire, patients' self-reported receipt of the e-information model in the past 2 months and their plans to quit within 1 month were collected. Multivariate logistic regression analysis was used to examine the association between receiving the e-information model and patients' plans to quit. RESULTS: Among 656 currently smoking patients, the proportion of patients receiving the Ask, Advise, Assess, Refer and Print components were 73.2%, 65.4%, 49.8%, 16.0% and 10.4%, respectively. The results revealed a dose-response relationship between the number of components received and the proportion of patients planning to quit (p-trend=0.006). The likelihood of patients planning to quit within 1 month was highest among those receiving all five components (OR=2.79, 95% CI: 1.31-5.94). Moreover, a simplified model composed of two or three components also revealed a potential effect on increasing the proportion of patients planning to quit. CONCLUSIONS: The e-information model was applied effectively in the study hospital and appeared to encourage patients to plan to quit smoking. This model could be generalized to other hospitals in China and other developing countries. However, many components of this model were less utilized, and comprehensive measures will be required to improve its application in the future.

7.
Crit Care ; 23(1): 300, 2019 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-31484582

RESUMEN

RATIONALE: Our pilot study suggested that noninvasive ventilation (NIV) reduced the need for intubation compared with conventional administration of oxygen on patients with "early" stage of mild acute respiratory distress syndrome (ARDS, PaO2/FIO2 between 200 and 300). OBJECTIVES: To evaluate whether early NIV can reduce the need for invasive ventilation in patients with pneumonia-induced early mild ARDS. METHODS: Prospective, multicenter, randomized controlled trial (RCT) of NIV compared with conventional administration of oxygen through a Venturi mask. Primary outcome included the numbers of patients who met the intubation criteria. RESULTS: Two hundred subjects were randomized to NIV (n = 102) or control (n = 98) groups from 21 centers. Baseline characteristics were similar in the two groups. In the NIV group, PaO2/FIO2 became significantly higher than in the control group at 2 h after randomization and remained stable for the first 72 h. NIV did not decrease the proportion of patients requiring intubation than in the control group (11/102 vs. 9/98, 10.8% vs. 9.2%, p = 0.706). The ICU mortality was similar in the two groups (7/102 vs. 7/98, 4.9% vs. 3.1%, p = 0.721). Multivariate analysis showed minute ventilation greater than 11 L/min at 48 h was the independent risk factor for NIV failure (OR, 1.176 [95% CI, 1.005-1.379], p = 0.043). CONCLUSIONS: Treatment with NIV did not reduce the need for intubation among patients with pneumonia-induced early mild ARDS, despite the improved PaO2/FIO2 observed with NIV compared with standard oxygen therapy. High minute ventilation may predict NIV failure. TRIAL REGISTRATION: NCT01581229 . Registered 19 April 2012.

8.
Lancet Planet Health ; 3(6): e270-e279, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31229002

RESUMEN

BACKGROUND: Air pollution in Beijing has been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013-17), but its implications for respiratory morbidity have not been directly investigated. We aimed to assess the potential effects of air-quality improvements on respiratory health by investigating the number of cases of acute exacerbations of chronic obstructive pulmonary disease (COPD) advanced by air pollution each year. METHODS: Daily city-wide concentrations of PM10, PM2·5, PMcoarse (particulate matter >2·5-10 µm diameter), nitrogen dioxide (NO2), sulphur dioxide (SO2), carbon monoxide (CO), and ozone (O3) in 2013-17 were averaged from 35 monitoring stations across Beijing. A generalised additive Poisson time-series model was applied to estimate the relative risks (RRs) and 95% CIs for hospitalisation for acute exacerbation of COPD associated with pollutant concentrations. FINDINGS: From Jan 18, 2013, to Dec 31, 2017, 161 613 hospitalisations for acute exacerbation of COPD were recorded. Mean ambient concentrations of SO2 decreased by 68% and PM2·5 decreased by 33% over this 5-year period. For each IQR increase in pollutant concentration, RRs for same-day hospitalisation for acute exacerbation of COPD were 1·029 (95% CI 1·023-1·035) for PM10, 1·028 (1·021-1·034) for PM2·5, 1·018 (1·013-1·022) for PMcoarse, 1·036 (1·028-1·044) for NO2, 1·019 (1·013-1·024) for SO2, 1·024 (1·018-1·029) for CO, and 1·027 (1·010-1·044) for O3 in the warm season (May to October). Women and patients aged 65 years or older were more susceptible to the effects of these pollutants on hospitalisation risk than were men and patients younger than 65 years. In 2013, there were 12 679 acute exacerbations of COPD cases that were advanced by PM2·5 pollution above the expected number of cases if daily PM2·5 concentrations had not exceeded the WHO target (25 µg/m3), whereas the respective figure in 2017 was 7377 cases. INTERPRETATION: Despite improvement in overall air quality, increased acute air pollution episodes were significantly associated with increased hospitalisations for acute exacerbations of COPD in Beijing. Stringent air pollution control policies are important and effective for reducing COPD morbidity, and long-term multidimensional policies to safeguard public health are indicated. FUNDING: UK Medical Research Council.

9.
Lancet ; 394(10196): 407-418, 2019 08 03.
Artículo en Inglés | MEDLINE | ID: mdl-31230828

RESUMEN

BACKGROUND: Asthma is a common chronic airway disease worldwide. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of asthma. We therefore aimed to estimate the national prevalence of asthma in a representative sample of the Chinese population. METHODS: A representative sample of 57 779 adults aged 20 years or older was recruited for the national cross-sectional China Pulmonary Health (CPH) study using a multi-stage stratified sampling method with parameters derived from the 2010 census. Ten Chinese provinces, representative of all socioeconomic settings, from six geographical regions were selected, and all assessments were done in local health centres. Exclusion criteria were temporary residence, inability to take a spirometry test, hospital treatment of cardiovascular conditions or tuberculosis, and pregnancy and breastfeeding. Asthma was determined on the basis of a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. All participants were assessed with a standard asthma questionnaire and were classed as having or not having airflow limitation through pulmonary function tests before and after the use of a bronchodilator (400 µg of salbutamol). Risk factors for asthma were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was assessed by the self-reported history of physician diagnosis, treatments, and hospital visits in people with asthma. FINDINGS: Between June 22, 2012, and May 25, 2015, 57 779 participants were recruited into the CPH study. 50 991 (21 446 men and 29 545 women) completed the questionnaire survey and had reliable post-bronchodilator pulmonary function test results and were thus included in the final analysis. The overall prevalence of asthma in our sample was 4·2% (95% CI 3·1-5·6), representing 45·7 million Chinese adults. The prevalence of asthma with airflow limitation was 1·1% (0·9-1·4), representing 13·1 million adults. Cigarette smoking (odds ratio [OR] 1·89, 95% CI 1·26-2·84; p=0·004), allergic rhinitis (3·06, 2·26-4·15; p<0·0001), childhood pneumonia or bronchitis (2·43, 1·44-4·10; p=0·002), parental history of respiratory disease (1·44, 1·02-2·04; p=0·040), and low education attainment (p=0·045) were associated with prevalent asthma. In 2032 people with asthma, only 28·8% (95% CI 19·7-40·0) reported ever being diagnosed by a physician, 23·4% (13·9-36·6) had a previous pulmonary function test, and 5·6% (3·1-9·9) had been treated with inhaled corticosteroids. Furthermore, 15·5% (11·4-20·8) people with asthma reported at least one emergency room visit and 7·2% (4·9-10·5) at least one hospital admission due to exacerbation of respiratory symptoms within the preceding year. INTERPRETATION: Asthma is prevalent but largely undiagnosed and undertreated in China. It is crucial to increase the awareness of asthma and disseminate standardised treatment in clinical settings to reduce the disease burden. FUNDING: National Key R&D Program of China, Ministry of Science and Technology of China; the Special Research Foundation for Public Welfare of Health, Ministry of Health of China; the Chinese National Research Program for Key Issues in Air Pollution Control; and the National Natural Science Foundation of China.


Asunto(s)
Asma/tratamiento farmacológico , Asma/epidemiología , Bronquitis/epidemiología , Fumar Cigarrillos/epidemiología , Neumonía/epidemiología , Rinitis Alérgica/epidemiología , Administración por Inhalación , Corticoesteroides/uso terapéutico , Adulto , Asma/etiología , Bronquitis/complicaciones , China/epidemiología , Fumar Cigarrillos/efectos adversos , Estudios Transversales , Manejo de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/complicaciones , Prevalencia , Rinitis Alérgica/complicaciones , Factores de Riesgo , Encuestas y Cuestionarios
10.
Am J Hypertens ; 32(6): 547-556, 2019 05 09.
Artículo en Inglés | MEDLINE | ID: mdl-30953049

RESUMEN

BACKGROUND: Metabolomics study may help identify novel mechanisms underlying arterial stiffening. METHODS: We performed untargeted metabolomics profiling among 1,239 participants of the Bogalusa Heart Study. After quality control, 1,202 metabolites were evaluated for associations with augmentation index (AI) and pulse wave velocity (PWV), using multivariate linear regression adjusting for age, sex, race, education, smoking, drinking, body weight, body height, physical activity, and estimated glomerular filtration rate. Heart rate, blood pressure and antihypertensive medication usage, lipids, and fasting glucose were sequentially adjusted in the sensitivity analyses for significant metabolites. Weighted correlation network analysis was applied to build metabolite networks. RESULTS: Six novel metabolites were negatively associated with AI, of which, 3-methyl-2-oxobutyrate had the lowest P value and the largest effect size (ß = -6.67, P = 5.99 × 10-6). Heart rate contributed to a large proportion (25%-58%) of the association for each metabolite. Twenty-one novel metabolites were identified for PWV, of which, fructose (ß = 0.61, P = 6.18 × 10-10) was most significant, and histidine had the largest effect size (ß = -1.09, P = 2.51 × 10-7). Blood pressure played a major contribution (9%-54%) to the association for each metabolite. Furthermore, 16 metabolites were associated with arterial stiffness independent of traditional risk factors. Network analysis identified 2 modules associated with both AI and PWV (P < 8.00 × 10-4). One was composed of metabolites from the glycerolipids synthesis and recycling pathway, and the other was involved in valine, leucine, and isoleucine metabolism. One module related to sphingomyelin metabolism was associated with PWV only (P = 0.002). CONCLUSIONS: This study has identified novel and important metabolites and metabolic networks associated with arterial stiffness.

11.
Mol Cancer ; 18(1): 1, 2019 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-30609930

RESUMEN

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is one of the most lethal malignancies. Neovascularization during tumorigenesis supplies oxygen and nutrients to proliferative tumor cells, and serves as a conduit for migration. Targeting oncogenes involved in angiogenesis is needed to treat organ-confined and locally advanced ESCC. Although the phospholipase C epsilon-1 (PLCE1) gene was originally identified as a susceptibility gene for ESCC, how PLCE1 is involved in ESCC is unclear. METHODS: Matrix-assisted laser desorption ionization time-of-flight mass spectrometry were used to measure the methylation status of the PLCE1 promoter region. To validate the underlying mechanism for PLCE1 in constitutive activation of the NF-κB signaling pathway, we performed studies using in vitro and in vivo assays and samples from 368 formalin-fixed esophageal cancer tissues and 215 normal tissues with IHC using tissue microarrays and the Cancer Genome Atlas dataset. RESULTS: We report that hypomethylation-associated up-regulation of PLCE1 expression was correlated with tumor angiogenesis and poor prognosis in ESCC cohorts. PLCE1 can activate NF-κB through phosphoinositide-phospholipase C-ε (PI-PLCε) signaling pathway. Furthermore, PLCE1 can bind p65 and IκBα proteins, promoting IκBα-S32 and p65-S536 phosphorylation. Consequently, phosphorylated IκBα promotes nuclear translocation of p50/p65 and p65, as a transcription factor, can bind vascular endothelial growth factor-C and bcl-2 promoters, enhancing angiogenesis and inhibiting apoptosis in vitro. Moreover, xenograft tumors in nude mice proved that PLCE1 can induce angiogenesis, inhibit apoptosis, and increase tumor aggressiveness via the NF-κB signaling pathway in vivo. CONCLUSIONS: Our findings not only provide evidence that hypomethylation-induced PLCE1 confers angiogenesis and proliferation in ESCC by activating PI-PLCε-NF-κB signaling pathway and VEGF-C/Bcl-2 expression, but also suggest that modulation of PLCE1 by epigenetic modification or a selective inhibitor may be a promising therapeutic approach for the treatment of ESCC.


Asunto(s)
Neoplasias Esofágicas/irrigación sanguínea , Neoplasias Esofágicas/genética , Carcinoma de Células Escamosas de Esófago/irrigación sanguínea , Carcinoma de Células Escamosas de Esófago/genética , Fosfoinositido Fosfolipasa C/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Animales , Apoptosis/fisiología , Línea Celular , Línea Celular Tumoral , Proliferación Celular/fisiología , Epigénesis Genética , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/patología , Carcinoma de Células Escamosas de Esófago/metabolismo , Carcinoma de Células Escamosas de Esófago/patología , Femenino , Células Endoteliales de la Vena Umbilical Humana , Humanos , Masculino , Ratones , Ratones Desnudos , Persona de Mediana Edad , FN-kappa B/genética , Neovascularización Patológica/genética , Neovascularización Patológica/metabolismo , Neovascularización Patológica/patología , Fosfoinositido Fosfolipasa C/genética , Proteínas Proto-Oncogénicas c-bcl-2/genética , Transducción de Señal , Regulación hacia Arriba , Factor A de Crecimiento Endotelial Vascular/genética
12.
Crit Care Med ; 47(3): e182-e189, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30531186

RESUMEN

OBJECTIVES: Managing hemoptysis in chronic thromboembolic pulmonary hypertension can be challenging due to the difficulties in maintaining coagulation homeostasis in affected patients. In this study, we evaluated the efficacy and safety of bronchial artery embolization in treating hemoptysis in chronic thromboembolic pulmonary hypertension patients. DESIGN: Pilot, prospective cohort study. SETTING: A large respiratory medical institute. PATIENTS: From January 1, 2012, to December 31, 2017, hospitalized chronic thromboembolic pulmonary hypertension patients were eligible for inclusion. Patients with pulmonary hypertension caused by other conditions, or who failed to participate in the follow-up were excluded. INTERVENTIONS: Hemoptysis in chronic thromboembolic pulmonary hypertension patients was treated with or without bronchial artery embolization based on whether the bleeding could be stopped with medication alone and patient willingness for bronchial artery embolization treatment. MEASUREMENTS AND MAIN RESULTS: A total of 328 patients diagnosed with chronic thromboembolic pulmonary hypertension were consecutively collected, 317 patients were completed the follow-up. There were 15 chronic thromboembolic pulmonary hypertension patients with hemoptysis in total, and the occurrence rate of hemoptysis in chronic thromboembolic pulmonary hypertension patients was 4.7%. Among the hemoptysis chronic thromboembolic pulmonary hypertension patients, 10 (67%) underwent bronchial artery embolization, and five (33%) were treated with medication only. The median follow-up period for hemoptysis patients was 7.6 months. In patients underwent bronchial artery embolization treatment, oxygenation index and right heart function showed no significant difference between pre bronchial artery embolization and post bronchial artery embolization. Hemoptysis relapse (20% vs 80%; p = 0.025) and hemoptysis-related mortality (0% vs 40%; p = 0.032) were significantly lower, whereas the overall survival (90% vs 40%; p = 0.040) was higher in patients treated with bronchial artery embolization than in patients treated without bronchial artery embolization. CONCLUSIONS: Bronchial artery embolization procedure demonstrated effectiveness and safety to treat hemoptysis in chronic thromboembolic pulmonary hypertension patients at our center, but further controlled studies are needed before it can be considered as an effective therapy for these patients.


Asunto(s)
Arterias Bronquiales , Embolización Terapéutica/métodos , Hemoptisis/terapia , Hipertensión Pulmonar/complicaciones , Embolia Pulmonar/terapia , Ecocardiografía , Femenino , Hemoptisis/etiología , Hemoptisis/mortalidad , Humanos , Hipertensión Pulmonar/mortalidad , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Embolia Pulmonar/complicaciones , Embolia Pulmonar/etiología , Embolia Pulmonar/mortalidad , Recurrencia
13.
Respir Res ; 19(1): 88, 2018 05 09.
Artículo en Inglés | MEDLINE | ID: mdl-29743116

RESUMEN

BACKGROUND: Preclinical data suggest that oncogene (EGFR and KRAS) events regulate tumor procoagulant activity. However, few studies have prospectively investigated the clinical relevance between the presence of EGFR or KRAS mutations and occurrence of venous thromboembolism(VTE) in patients with non-small cell lung cancer (NSCLC). METHODS: A total of 605 Chinese patients with newly diagnosed NSCLC were included and were followed for a maximum period of 4.5 years. EGFR and KRAS mutations were determined by amplification refractory mutation system polymerase chain reaction method at inclusion. The main outcome was objectively confirmed VTE. RESULTS: Of the 605 patients, 40.3% (244) had EGFR mutations and 10.2% (62) of patients had KRAS mutations. In multivariable analysis including age, sex, tumor histology, tumor stage, performance status, EGFR and KRAS status, EGFR wild-type (sub-distribution hazard ratio 1.81, 95% confidence interval 1.07-3.07) were associated with the increased risk of VTE. In competing risk analysis, the probability of developing VTE was 8.3% in those with and 13.2% in those without EGFR mutations after 1 year; after 2 years, the corresponding risks were 9.7 and 15.5% (Gray test P = 0.047). CONCLUSIONS: EGFR mutations have a negative association with the risk of VTE in Chinese patients with NSCLC.


Asunto(s)
Biomarcadores de Tumor/genética , Carcinoma de Pulmón de Células no Pequeñas/genética , Genes erbB-1/genética , Estudios de Asociación Genética/métodos , Neoplasias Pulmonares/genética , Tromboembolia Venosa/genética , Anciano , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Estudios de Cohortes , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Mutación/genética , Estudios Prospectivos , Proteínas Proto-Oncogénicas p21(ras)/genética , Factores de Riesgo , Tromboembolia Venosa/epidemiología
14.
Lancet ; 391(10131): 1706-1717, 2018 04 28.
Artículo en Inglés | MEDLINE | ID: mdl-29650248

RESUMEN

BACKGROUND: Although exposure to cigarette smoking and air pollution is common, the current prevalence of chronic obstructive pulmonary disease (COPD) is unknown in the Chinese adult population. We conducted the China Pulmonary Health (CPH) study to assess the prevalence and risk factors of COPD in China. METHODS: The CPH study is a cross-sectional study in a nationally representative sample of adults aged 20 years or older from ten provinces, autonomous regions, and municipalities in mainland China. All participants underwent a post-bronchodilator pulmonary function test. COPD was diagnosed according to 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. FINDINGS: Between June, 2012, and May, 2015, 57 779 individuals were invited to participate, of whom 50 991 (21 446 men and 29 545 women) had reliable post-bronchodilator results and were included in the final analysis. The overall prevalence of spirometry-defined COPD was 8·6% (95% CI 7·5-9·9), accounting for 99·9 (95% CI 76·3-135·7) million people with COPD in China. Prevalence was higher in men (11·9%, 95% CI 10·2-13·8) than in women (5·4%, 4·6-6·2; p<0·0001 for sex difference) and in people aged 40 years or older (13·7%, 12·1-15·5) than in those aged 20-39 years (2·1%, 1·4-3·2; p<0·0001 for age difference). Only 12·0% (95% CI 8·1-17·4) of people with COPD reported a previous pulmonary function test. Risk factors for COPD included smoking exposure of 20 pack-years or more (odds ratio [OR] 1·95, 95% CI 1·53-2·47), exposure to annual mean particulate matter with a diameter less than 2·5 µm of 50-74 µg/m3 (1·85, 1·23-2·77) or 75 µg/m3 or higher (2·00, 1·36-2·92), underweight (body-mass index <18·5 kg/m2; 1·43, 1·03-1·97), sometimes childhood chronic cough (1·48, 1·14-1·93) or frequent cough (2·57, 2·01-3·29), and parental history of respiratory diseases (1·40, 1·23-1·60). A lower risk of COPD was associated with middle or high school education (OR 0·76, 95% CI 0·64-0·90) and college or higher education (0·47, 0·33-0·66). INTERPRETATION: Spirometry-defined COPD is highly prevalent in the Chinese adult population. Cigarette smoking, ambient air pollution, underweight, childhood chronic cough, parental history of respiratory diseases, and low education are major risk factors for COPD. Prevention and early detection of COPD using spirometry should be a public health priority in China to reduce COPD-related morbidity and mortality. FUNDING: Ministry of Health and Ministry of Science and Technology of China.


Asunto(s)
Contaminación del Aire/efectos adversos , Exposición por Inhalación/efectos adversos , Material Particulado/efectos adversos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Fumar/efectos adversos , Administración por Inhalación , Adulto , Anciano , Contaminación del Aire/prevención & control , Albuterol/administración & dosificación , Albuterol/farmacología , Broncodilatadores/administración & dosificación , Broncodilatadores/farmacología , China/epidemiología , Estudios Transversales , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Exposición por Inhalación/prevención & control , Masculino , Persona de Mediana Edad , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Pruebas de Función Respiratoria/métodos , Factores de Riesgo , Fumar/epidemiología , Capacidad Vital/efectos de los fármacos
15.
Clin Respir J ; 12(4): 1591-1597, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28960850

RESUMEN

INTRODUCTION: Mechanical prophylaxis with graduated compression stockings (GCS) or intermittent pneumatic compression (IPC) is suggested for patients who are bleeding or at high risk for major bleeding. OBJECTIVES: To explore how intensive care unit (ICU) medical staff in North China comprehend and practice mechanical thromboprophylaxis. METHODS: Questionnaires comprising 39 questions including 4 dimensions of thromboprophylaxis were administered in ICUs in North China. RESULTS: Fifty-two ICUs were surveyed from September 2014 to January 2015. A total of 2500 questionnaires were sent and 1861 were returned, corresponding to approximately 74.4%. Approximately 52.30% of all surveyed medical staff indicated they often practiced mechanical thromboprophylaxis. Twenty-five percentage of them never used or had never heard of mechanical thromboprophylaxis. Thirty-eight percent and twenty-four percent of them doubted the effectiveness of GCS and IPC respectively. Regarding the use of GCS, 50.2% of them were concerned about skin injury, 57.4% were concerned about difficulty with removal and 57.6% were anxious about discomfort. Thirty-five percent of the medical staff feared the ease of thrombus release during IPC thromboprophylaxis. CONCLUSIONS: A wide gap exists with regards to the knowledge and application of mechanical thromboprophylaxis for venous thromboembolism (VTE) between the medical staff of our country and abroad. Strengthened standardized training may help medical staff improve their understanding and application of mechanical thromboprophylaxis. Amelioration of concerns regarding IPC and GCS could help increase the rate of mechanical thromboprophylaxis for VTE, reduce the occurrence of VTE in ICUs and improve the prognosis of these critically ill patients.


Asunto(s)
Anticoagulantes/uso terapéutico , Adhesión a Directriz/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Unidades de Cuidados Intensivos/estadística & datos numéricos , Aparatos de Compresión Neumática Intermitente/estadística & datos numéricos , Encuestas y Cuestionarios , Tromboembolia Venosa/prevención & control , China/epidemiología , Femenino , Humanos , Incidencia , Masculino , Factores de Riesgo , Tromboembolia Venosa/epidemiología
16.
Chin Med J (Engl) ; 130(18): 2170-2175, 2017 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-28875952

RESUMEN

Background:: Preoperative anatomical scoring system is conducive to comparison between treatment options and evaluation of postoperative outcomes in patients with small renal tumors. This study aimed to evaluate the clinical application efficacy of the R.E.N.A.L. nephrometry score (RNS) in predicting perioperative outcomes in patients with renal tumor who underwent laparoscopic partial nephrectomy (LPN). Methods:: The clinical data of 139 patients with renal tumors who underwent LPN between 2009 and 2015 were collected and analyzed. Patients were divided into three groups according to their RNS (low, moderate, and high). Clinical characteristics including perioperative variables, complications, and RNS were compared to evaluate the differences between the three groups. Multivariable logistic regression analysis was used to analyze the risk factors of postoperative complications. Results:: According to the RNS, there were 74, 50, and 15 patients in the low, moderate, and high RNS groups, respectively. There were significant differences in estimated blood loss (EBL; χ2 = 7.285, P = 0.026), warm ischemia time (WIT; χ2 = 13.718, P = 0.001), operation time (OT; χ2 = 6.882, P = 0.032), perioperative creatinine clearance change (PCCC; χ2 = 6.206, P = 0.045), and number of patients with complications (NPC; P = 0.002) among the three groups. The values for EBL, WIT, OT, PCCC, and NPC for patients in the high RNS group were higher than those for patients in the low RNS group. After adjustment for OT, WIT, and EBL, RNS was statistically significantly associated with the risk of postoperative complications in a multivariable logistic regression model (odds ratio = 1.541, 95% confidence interval: 1.059-2.242, P = 0.024). Conclusions:: The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy. It can aid surgeons in preoperative decision-making concerning management therapy. Future multicenter, large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.


Asunto(s)
Neoplasias Renales/cirugía , Nefrectomía/métodos , Adulto , Anciano , Índice de Masa Corporal , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Riñón/patología , Riñón/cirugía , Laparoscopía , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos
17.
J Infect Public Health ; 10(6): 794-798, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28188118

RESUMEN

A hospital-based surveillance of shigellosis was conducted in Taiyuan from 2005 to 2015. A total of 2655 stool cultures were collected from patients with diarrhea, 115 were identified as S. flexneri and 107 were S. sonnei. The highest infection rates were found among children under 5 years of age (34.2 %), and during the summer (61.0 %). ​Six serotypes were identified among S. flexneriisolates:1a, 2a, 2b, Xv, X and Y. Serotype 2a and Xv were the dominant serotypes in two periods, 2012-2015 and 2005-2008, respectively. High shigellosis rates over the past decade highlight shigellosis is still a major public health problem in Taiyuan.


Asunto(s)
Disentería Bacilar/epidemiología , Tipificación Molecular , Serotipificación , Shigella flexneri/clasificación , Shigella flexneri/aislamiento & purificación , Shigella sonnei/clasificación , Shigella sonnei/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China/epidemiología , Disentería Bacilar/microbiología , Monitoreo Epidemiológico , Heces/microbiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Shigella flexneri/genética , Shigella sonnei/genética , Adulto Joven
18.
BMC Public Health ; 17(1): 148, 2017 02 02.
Artículo en Inglés | MEDLINE | ID: mdl-28148238

RESUMEN

BACKGROUND: Brachial-ankle pulse wave velocity (baPWV) is an independent predictor of cardiovascular events and mortality. However, there is no related data on the association of baPWVwith coal workers' pneumoconiosis (CWP). We explored the baPWV in subjects withCWP and the associated risk factors. METHODS: Thiscase-control study included 1,007 male CWP cases without a history of stroke and coronary heart disease and 1,007 matched controls from the Kailuan cohort study. All of the participants underwent assessment for baPWV and traditional cardiovascular risk factors. The cumulative silica dust exposure (work history linked to a job-exposure matrix) was estimated for the CWP cases. RESULTS: Compared with the controls, the CWP cases had higher baPWV (1762.0 ± 355 cm/s vs. 1718.6 ± 354 cm/s, P = 0.006) and a higher risk of increased baPWV (defined as more than the median baPWV of the population distribution; odds ratio 1.43, 95% confidence interval 1.11-1.83) after adjusting for traditional cardiovascular risk factors. Age ≥60 years, body mass index, heart rate, and hypertension were all significantly associated with increased baPWV in the CWP cases. Compared to non-CWP subjects without hypertension, the odds ratios for increased baPWV gradually increased (P for trend, 0.001) across the CWP subjects without hypertension (odds ratio 1.20, 95%confidence interval 0.90-1.61), subjects with hypertension alone (odds ratio 2.54, 95% confidence interval 1.95-3.30), and CWP subjects with hypertension (odds ratio 3.34, 95% confidence interval 2.56-4.37). We detected a significant positive exposure-response relationship between silica dust-exposure quartiles and increased baPWV in CWP cases (P for trend < 0.001). CONCLUSIONS: For patients with CWP, increased baPWV was associated with traditional cardiovascular risk factors and long-term silica dust exposure.


Asunto(s)
Índice Tobillo Braquial/estadística & datos numéricos , Antracosis/epidemiología , Antracosis/fisiopatología , Mineros/estadística & datos numéricos , Análisis de la Onda del Pulso/estadística & datos numéricos , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Estudios de Casos y Controles , China/epidemiología , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo
19.
Clin Respir J ; 11(5): 640-647, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26425916

RESUMEN

OBJECTIVES AND AIMS: To investigate urokinase-(uPA) and tissue-type (tPA) plasminogen activator and plasminogen activator inhibitor type-1 (PAI-1) levels in patients with idiopathic pulmonary fibrosis (IPF) and to determine the relationship between fibrinolytic system and pulmonary arterial pressure and pulmonary function. METHODS: Seventy-nine patients with IPF were included. Bronchoalveolar lavage fluid (BALF) and blood samples were collected. The concentrations of tPA, uPA and PAI-1 were measured using enzyme-linked immunosorbent assay. Doppler echocardiography was used to detect tricuspid regurgitation pressure gradient (TRPG) to estimate pulmonary arterial pressure. RESULTS: BALF tPA elevated (P < 0.005), circulatory PAI-1 decreased (P = 0.05) and the ratio of uPA and PAI-1 decreased (P = 0.01) in BALF in IPF patients with pulmonary hypertension (PH) compared to those without PH. Positive linear correlations were found: BALF tPA and TRPG (r = 0.558, P = 0.013); the predicted percentage of diffusion capacity of lung for carbon monoxide adjustments for alveolar volume and BALF uPA (r = 0.319, P = 0.035). Negative linear correlations were as follows: BALF PAI-1 and the predicted percentage of VCmax (r = -0.325, P = 0.020), or total lung capacity (r = -0.312, P = 0.033); circulatory PAI-1 and TRPG (r = -0.697, P = 0.003). CONCLUSIONS: The change of alveolar fibrolytic system in IPF, especially the uPA reduction and the PAI-1elevation, contributes to the deterioration of lung function. During the lung injury initiating fibrosis, tPA and PAI-1 might be leaked out of the pulmonary capillaries into alveoli, resulting in their elevation in alveoli and reduction in circulation, and finally contributing to the development of PH in IPF.


Asunto(s)
Presión Arterial/efectos de los fármacos , Fibrinólisis/fisiología , Hipertensión Pulmonar/metabolismo , Fibrosis Pulmonar Idiopática/sangre , Alveolos Pulmonares/metabolismo , Pruebas de Función Respiratoria/métodos , Anciano , Líquido del Lavado Bronquioalveolar/química , Ecocardiografía Doppler/métodos , Femenino , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/mortalidad , Fibrosis Pulmonar Idiopática/diagnóstico , Fibrosis Pulmonar Idiopática/patología , Fibrosis Pulmonar Idiopática/fisiopatología , Masculino , Persona de Mediana Edad , Inhibidor 1 de Activador Plasminogénico/metabolismo , Alveolos Pulmonares/patología , Activador de Tejido Plasminógeno/metabolismo , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/fisiopatología , Activador de Plasminógeno de Tipo Uroquinasa/metabolismo
20.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 36(6): 668-73, 2016 Jun.
Artículo en Chino | MEDLINE | ID: mdl-27491223

RESUMEN

OBJECTIVE: To develop a life quality scale suitable for idiopathic pulmonary fibrosis (IPF) patients, objectively reflecting its changes. METHODS: Authors first put forward a theoretical structure model of a scale according to patient-reported outcome (PRO) scale formulation principle by combining basic theories of Chinese medicine (CM). Then authors developed an initial scale on the basis of various life quality scales for respiratory disease patients by using structural decision making. Totally 34 patients with confirmed diagnosis of IPF were tested by questionnaire. Items were screened using expert importance scoring method, factor analysis, correlation coefficient method, Cronbach's alpha coefficient method. IPF patient reported outcomes (IPF PRO, IP) were finally defined. RESULTS: A new IP scale was developed covering three areas and 38 items. Pearson correlation coefficient for correlation analysis of clinical symptom scores in ST-George Respiratory Questionnaire and IP scale was 0.828 (P < 0.01). Pearson correlation coefficient for correlation analysis of activity ability scores was 0.929 (P < 0.01). Pearson correlation coefficient for correlation analysis of total scores was 0.862 (P < 0.01). By reliability of IP scale itself (reliability) analysis, Cronbach's alpha coefficient was 0.713. By using factor analysis method for data analysis, KMO statistics was 0.902. CONCLUSION: IP scale fully reflected the connotation of IPF patients' quality of life, so it could be used as CM clinical therapeutic effect evaluation tool.


Asunto(s)
Fibrosis Pulmonar Idiopática/diagnóstico , Medicina China Tradicional , Calidad de Vida , Encuestas y Cuestionarios , Humanos , Reproducibilidad de los Resultados , Proyectos de Investigación
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